Individual
MANUEL R ROSALES
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
388 HAWKINS AVE, STE 1, LAKE RONKONKOMA, NY 11779-4280
(631) 588-8460
(631) 588-8480
Mailing address
388 HAWKINS AVE, STE 1, LAKE RONKONKOMA, NY 11779-4280
(631) 588-8460
(631) 588-8480
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
207409
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01762096
—
NY
Enumeration date
06/01/2005
Last updated
07/08/2007
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